Diagnostic and surgical challenges in resection of cerebellar angle tumors and acoustic neuromas

Abstract

Background:Cerebellopontine angle (CPA) lesions can mimic more common tumors through nonspecific symptoms and radiologic findings.Methods:To increase the preoperative diagnostic accuracy for CPA pathologies, the authors review the full spectrum of reported CPA lesions.Results:A wide spectrum of lesions mimics vestibular schwannoma (VS) in the space of the CPA.Conclusion:The presence of any suspicious clinical and radiographic finding uncharacteristic of VS makes it necessary to maintain a broad differential diagnosis list. Differentiation of CPA lesions, although challenging, may be best achieved by incorporating the clinical history, physical exam findings, audiometry results, and multi-modality imaging studies to construct a comprehensive preoperative knowledge of the lesion. This knowledge will allow improved operative execution and outcomes.

Cerebellopontine Angle Anaplastic Ependymoma: A Case Report and Literature Review

“…A wide spectrum of lesions occurs in the space of the CPA. In adults, benign tumors are more common including vestibular schwannomas (70-80%), meningiomas (10-15%) and epidermoid cysts (3-7%) (Patel, 2012). Vestibular schwannomas are the most common lesion within the CPA space, typically arising from the inferior vestibular portion of the VIII cranial nerve.…”

“…Accounting for approximately 3% of all primary central nervous system neoplasms, ependymal tumors are rare neoplasms of neuroectodermal origin arising from ependymal cells in the obliterated central canal of the spinal cord, the filum terminale, choroid plexus or white matter adjacent to the highly angulated ventricular surface (Patel, 2012;Yang, 2016). Additionally, ependymal tumors can be found in the brain parenchyma as a result of fetal ependymal cell rests migrating from periventricular areas.…”

“…The remaining abnormalities found at CPA space account for less than 1% of all lesions in this region (Patel, 2012). Such as CPP, although exceedingly rare, needs to be taken into account.…”